Graded Impairment and Pattern Evolution of Global Longitudinal Strain in Coronary Artery Disease: A Systematic Review of Anatomical Complexity

Abstract

Background & Aims: Global longitudinal strain (GLS) derived from two-dimensional speckle-tracking echocardiography is increasingly recognized as a sensitive marker of subclinical myocardial dysfunction. Its relationship to the anatomical extent and distribution of coronary artery disease (CAD), however, remains incompletely synthesized. This review aims to evaluate differences in resting GLS according to coronary vessel involvement and to characterize regional versus diffuse strain patterns across varying degrees of CAD severity. Methodology: A systematic search of PubMed, Cochrane Library, and ScienceDirect was conducted. Studies were included if they assessed resting GLS in adults with angiographically confirmed CAD and stratified disease by vessel count or anatomical complexity. Qualitative synthesis was performed due to methodological heterogeneity. Results: Twelve observational studies met inclusion criteria. Across vessel-count classifications, GLS progressively declined from normal coronary arteries to single-, double-, triple-vessel, and left main disease. Similar inverse associations were observed between GLS magnitude and SYNTAX score. In single-vessel disease, strain reduction tended to localize to affected territories, whereas multivessel involvement was associated with more diffuse longitudinal impairment despite preserved ejection fraction. Longitudinal strain reflects cumulative subendocardial ischemic burden and demonstrates a dose–response relationship with coronary disease extent. The transition from regional to diffuse dysfunction may represent a functional signature of increasing anatomical involvement. Conclusion: Resting GLS is closely associated with coronary artery disease burden and distribution, supporting its role as a noninvasive marker of ischemic severity.